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Ensuring optimum care temperature with the Care Thermometer: validation and use ARTICLE BY LINN STEER Arjo AB, Scheelevagen 19F, SE-223 70 Lund, Sweden and HANNEKE JJ KNIBBE, MSC LOCOmotion Research, Brinkerpad 29, 6721WJ Bennekom, The Netherlands
Abstract: The Care Thermometer is an easy-to-use, web-based, self-assessment tool, designed to provide an efficient and reliable overview of the present situation in two specific areas: the physical care load and prevention policy in a unit or facility. In short it provides a quick reading of the care “temperature”. The Care Thermometer allows the users to assess the current situation in their facility today, and, with regular use, it can help track progress over time. The Care Thermometer is a further step in the development of the TilThermometer©, a validated assess ment tool (Knibbe & Friele, 1999).
Introduction: the Care Thermometer ✚ static loads, such as bending over a patient for prolonged Healthcare facilities implementing ergonomic policies in the periods during activities like wound care or washing and nursing profession feel an increased need to monitor and fine tune bathing. their policies. They invest considerable effort and money in the implementation process. Management therefore will need data to The assessments from the Care monitor progress and promote further change. Currently their Thermometer are also intended to be used to refine or design an vision is often limited to data on sick leave and costs of injuries and effective injury prevention policy. Findings from the Care compensation claims. Additional data might allow for a faster and Thermometer can, for example, provide the basis for well- more sensitive monitoring on a ward level and provide a means to informed decisions on better alloca tion of equipment or provision tailor policies to the exact situation per ward. of new equipment to ensure safe, high-quality care. For this purpose the Care Thermometer was developed and a By using the Care Thermometer on a regular basis it is possible further study is undertaken to validate the Care Thermometer. The to monitor progress over time and redirect whenever and Care Thermometer is originally based on the Dutch wherever necessary. Regular readings of the Care Thermometer ‘TilThermometer©‘ developed by Knibbe et al. in the Netherlands for a specific unit or the facility will provide a good picture of the (Knibbe & Friele, 1999). The TilThermometer was adapted for all change in mobility levels, how this impacts the physical care load health care sectors, tested by focus groups and is currently used and if chan ges in equipment usage are necessary. on a large, national scale on a regular basis. This tool is endorsed by unions, employers and the Health and Safety Inspectorate. Assessment of patients Currently about 80% of all clients in geriatric care have been One of the most important starting points for the design of a assessed with the TilThermometer. The tool is also widely used in preventive policy is an assessment of the type and amount of other health care sectors in the Netherlands. These databases assistance patients require. In the Care Thermometer this is assist in the validation process of the Care Thermometer. summarised in the word “physical care load”. When compared to the TilThermometer, the Care Thermometer For the purpose of monitoring the physical care load, the Care is more comprehensive as it specifies more sources of potential Thermometer uses a five-level classification system ranging from physical overexposure. It also explicitly covers issues related to completely independent (category A) to fully dependent (category quality of care, whereas the TilThermometer is primarily an E) patients. The assessment of mobility is based on the functional occupational and ergonomic tool. mobility level of patients, not the exact nature, or diagnosis, of their disease, impairment or disability. The first step is therefore to Exposure assessment and physical care load assess and classify all patients in this five-level system. Although The Care Thermometer focuses on the assessment of exposure. it may be difficult to place some individual patients in one of the The reason for this is that research demonstrates a correlation five groups, the general picture appears to be reliable enough to between high levels of exposure to physical loads and the base policy decisions on. prevalence of musculoskeletal disorders. Therefore, exposure assessment is a sensitive and practical way of designing and Safety measures in place evaluating a preventive policy. This holds especially true in nursing The second basic element in the design of a policy is formed by for exposure to: the measures that are already taken or in place so carers can ✚ dynamic loads, such as lifting and transferring passive work safely. patients, and also to The Care Thermometer assesses the presence of the different
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Sponsored feature: Arjo AB
types of equipment and relates this to the physical care load and ambitious a validation study of the Care Thermometer is the mobility level of the patients. The outcome will be an overview undertaken. This will provide an indication of the quality of the data of the levels of care load risk involved in each activity and also per gathered with the tool. In the validation process the following patient mobility level. The three levels of risk are symbolised by the research questions will be answered: colours red, yellow and green: 1) Are the parameters of the CT complete? ✚ Red risk level: Transfer or activity is “unacceptable” for the 2) Do these parameters actually measure what they intend to carer/s. The assessment has revealed a high risk of physical measure? overload during the transfer or activity when comparing 3) Does the CT produce valid and reliable results in real life equipment provision to patient mobility. A more detailed risk conditions? assessment should be undertaken and escalated as 4) Are the parameters and the tool itself sensitive enough to appropriate immediately. This may include involvement of your highlight specific differences across health care sectors and Moving and Handling Advisor or appropriate Clinical Manager. across countries? ✚ Yellow risk level: Transfer or activity is “unsafe” for the carer/s. The assessment has revealed a medium risk of One of the options for validation-studies is to combine data physical overload during the transfer or activity when gathered from different angles and measurement “sources” in order comparing equipment provision to patient mobility. A risk to determine the level of converging-validity. If the results of different assessment should be undertaken as soon as possible to sources converge, this can be considered as an indication of the ensure adequate controls are in place. validity. And, the other way around, a lack of convergence can ✚ Green risk level: Transfer or activity is “safe” for the carer/s. pinpoint weaknesses in the validity of the tool. It will therefore need The assessment has revealed a low risk of physical overload improvement. The results of the following three data sources during the transfer or activity when comparing equipment (‘triangulation’) are currently being compared with the actual use and provision to patient mobility and activities. results of the Care Thermometer. 1) real life observations, quantitative and qualitative evaluation on Quality of care the ward; Prevention and reduction of occupational risks is, of course, not 2) the use of the StaDyMeter; only a matter of the right equipment. At least of equal importance 3) the use of the RiskRadar. is the maintenance and, if possible, improvement of mobility and independence within the patient population. Ad 1: The results will be compared with the results the facilities The Care Thermometer not only determines if the amount and themselves collect on the Care Thermometer. type of equipment is adequate from a safety point of view, it also Ad 2: The StaDyMeter is a self-administered log used before in identifies if patient mobility and activity is stimulated or if too much the validation process of the original TT and will now again provide assistance is given and there is a risk of rendering the patients relevant input and the option of comparing the results with the passive. reference data collected in the validation process of the TT (Knibbe & Friele, 1999 and Knibbe et al. 2002- 2007). This tool collects data Activities included in the Care Thermometer on a ward or team level, is quantitatively oriented and is more The following care tasks were identified as the most pronounced detailed than the TilThermometer and the Care Thermometer. potential occupational risks. For this reason they were included in Ad 3: The RiskRadar is a protocolized tool that analyses the the Care Thermometer: exposure to physical load on an individual (nurse) level. It will not only 1) repositioning in bed; assess the exposure itself quantitatively, but will also check for 2) lateral transfers; missed sources of overload and will also additionally for each of the 3) general transfers; sources found assess the level of physical load that nurses 4) hygiene care in a sitting position; experience. This subjective experience is also important, not only 5) showering in a supine position; because it is relevant in itself, but also as it may provide a source of 6) bathing; bias in the data gathered with the Care Thermometer. 7) transfers to/from bath; For the validation study four countries are included and for each 8) care on the bed; country 4 facilities participate: two from long stay and nursing 9) use of compression stockings (AES). homes and two from acute care. After this process the results of these three sources will be combined and the differences and Care Thermometer in practice degree of convergence with the results of the Care Thermometer will With information from the Care Thermometer, one can further be determined. This will lead to a final conclusion as to the validity refine or design a prevention policy. The results will provide clear of the Care Thermometer and also (directions for) possible leads to tailor the policy and prioritise steps in a policy or action adaptations that might improve its validity. y plan. This may result, for example, in a sound factual basis for decisions on additional equipment or re-distribution of equipment. This validation study is sponsored by ARJO AB. Over time, the Care Thermometer can be used to evaluate progress. By comparing new results with the ones from previous References assessments, it is easy to follow changes in care load risk levels 1. Knibbe J.J. and Friele D., 1999, The use of logs to assess exposure to manual handling of as well as quality of care. patients illustrated in an intervention study in home care nursing, International Journal of Industrial Ergonomics, 24: 445-54. 2. Knibbe J.J., Knibbe N.E., 2008 (in press), Fourth National Monitoring with the Lift Validation process Thermometer, SAB V&V, The Hague, (in Dutch). As the claims of the Care Thermometer (CT) are obviously
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